Parental strategies for promoting physical activity in elementary-aged children

Promoting Physical Activity in Elementary-School Aged Children: What Parents Can Do

By now, everyone understands that childhood obesity is a serious problem, and it almost impossible to overstate the seriousness of that problem. "Over the past 20 years, obesity rates in U.S. children and youth have skyrocketed. Among children ages 6 to 11, 15.8% are overweight (?95th percentile body mass index [BMI] for age) and 31.2% are overweight or at risk for overweight (?85th percentile BMI for age)" (Pate et al., 2011). These rates increase as children age, so that overweight children are very likely to grow into overweight adults. Even more problematic is that these rates continue to grow. If current trends continue, "in children, the prevalence of overweight…will nearly double by 2030" (Yang et al., 2008). Since, overweight children are very highly predictive of overweight adults, this means a greatly increased burden on the healthcare system. "Total health-care costs attributable to obesity/overweight would double every decade to 860.7-956.9 billion U.S. dollars by 2030, accounting for 16-18% of total U.S. health-care costs" (Yang et al., 2008). Even more alarming, by 2048, "all American dadults would become overweight or obese" (Yang et al., 2008). In order to curb this alarming trend, America has to figure out how to prevent obesity in children, since preventing childhood obesity appears to be the key to preventing adult obesity.

Subject group

It only makes sense to try to instill healthy habits in children while they are young. The longer the kids have healthy habits, the less likely they are to experience the negative consequences of bad choices. In addition, a child who fails to develop negative eating and physical activity behaviors never has to struggle to unlearn those unhealthy habits. Any person who has ever struggled with weight knows that it is far easier not to put the weight in the first place than it is to struggle to take off the weight. Moreover, there are real health consequences for elementary-school aged children who are struggling with obesity. These physical health consequences include: type-II diabetes, sleep apnea, heart disease, asthma, orthopedic problems, hypertension, and malnutrition (Oliver Foundation, 2011). However, the negative consequences of childhood obesity can go way beyond physical health consequences, which can often be mitigated by lifestyle changes in later years; in many instances, obese children suffer severe emotional consequences (Oliver Foundation, 2011). These psychological consequences can include: low self-esteem, poor social functioning, depression, body image disturbance, eating-disordered behavior, and behavior problems (Oliver Foundation, 2011). Unlike the physical effects of being obese, some of these psychological consequences may not ever be completely remedied.

Background

There is not a single culprit in the childhood obesity epidemic. If there were a single culprit, there probably would not be a childhood obesity epidemic. Instead, multiple factors contribute to the problem. Certainly, children are eating worse than they have in the past, and while high-fructose corn syrup may not be the evil that some suggest it is, it certainly is not healthy. Highly processed, calorie-dense and nutrient poor foods contribute to overeating, as the body searches for satiety. School lunches are notorious for their lack of real nutritional value. Serving sizes, even of healthy foods have increased. In other words, the nutritional outlook for children is grim.

However, it would be over-simplifying things to suggest that dietary habits, alone, can be held responsible for this obesity explosion. There is also the question of physical activity. Nationwide, school physical education (P.E.) programs have been on decline. Some schools have eliminated P.E. classes, while others have simply reduced them. While a reduction in P.E. is most likely to impact older students, elementary-aged children feel the impact as well. Not only have they experienced a reduction in P.E. classes, but some of them do not get any opportunity during the school day to engage in physical activity; "even recess has been reduced or eliminated in some elementary schools" (Pate et al., 2011). Examining physical activity during a child's school day, it becomes clear that the vast majority of children are not coming anywhere close to achieving physical activity goals during the school days, and that girls are even less likely than boys to reach recommended activity goals (Nettlefold et al., 2011). Furthermore, kids are less likely to use physical activity to get to and from school; "only one third of trips to school ?1 mile and

Furthermore, because elementary aged kids spend the majority of their waking hours in schools, the emphasis has been to try to increase physical exercise during school hours. The recommendation is that children participate in at least an hour every day of "physical activity that is developmentally appropriate, enjoyable, and involves a variety of activities" (Pate et al., 2011). The hour does not have to occur at a single time, but can be accumulated throughout the day. However, particularly during the current recession, it is highly unlikely that schools experiencing fiscal crisis are going to place their financial resources in expanding P.E. programs, particularly when resources are needed for academics. People may want more physical activity during the school day, but those wants do not appear to be translating into a significant positive change in the amount of physical activity students get during the day. On the contrary, there appears to be a continuous decline in physical activity for school children during school hours. What that makes clear is that if parents want their children to get 60 minutes or more of physical activity every day, parents are going to have to stop relying on the schools to do the job, and make an effort to get active with their children.

Finally, it is clear that parents need to help shape their children's attitudes about physical activity. Many children seem to approach physical activity as an unpleasant chore to be accomplished (LaFontaine, 2008). This mirrors the attitudes of many adults, who do not incorporate physical activity into their daily routines, and view "working out" or "exercising" as something separate and apart from daily life. Many children may see physical activity as a punishment, such as when a parent dictates that the child move away from a screen and get physically active. They may see physical activity as unpleasant, not liking the exertion required for the activity. Moreover, the less fit a child is, the more strenuous and difficult the child is likely to find physical activity, which increases avoidance behaviors. Furthermore, some subgroups of children are more likely to avoid physical activity than other subgroups. For example, black adolescent girls are very likely to be sedentary and may have very negative attitudes towards physical activity (Thompson, 2011). Without parents getting involved an encouraging physical activity, it is difficult to see how anyone could intervene and help change negative attitudes about physical activity into positive attitudes. Moreover, it seems clear that a pre-adolescent intervention is more likely to have enduring success than an intervention during adolescence, if only because teenagers are notoriously resistant to anything adults attempt to suggest to them.

Interventions

Current interventions

One way that parents have responded to the childhood obesity epidemic is to enroll their children in sports. There is an assumption that sports participation provides health benefits. However, while the overall conclusion is that sports can be beneficial to the children who participate in them, the correlation between sports participation and health benefits is not always clear-cut (Pate et al., 2011). In fact, white children who participate in sports are more likely to engage in more positive and less negative health behaviors than black or Hispanic students (Pate et al., 2011). Even the physical consequences may be uncertain. Overall, students who participate in sports are likely to have lower body fat percentiles than students who do not participate in sports, which seems particularly relevant to the issue of childhood obesity (Ara et al., 2004).

However, while sports may be a positive for some children, it is important to realize that sports are not a universal positive. There are some negative health behaviors that might be associated with sports participation, including, but not limited to, eating disorders like anorexia (Pate et al., 2000). Furthermore, one must consider the emotional environment and context of sports. Team sports can be very highly competitive, even on the elementary-school level. It is positive for children to be exposed to a hyper-competitive environment where the emphasis is on winning, rather than on health? In these environments, the very students who are most likely o need additional exercise time- those who are weaker, heavier, or slower than their peers, are the most likely to spend time on the bench and not get an actual opportunity to exercise. Moreover, these negative attitudes are likely to impact the way that children feel about physical activity, and transform it from something positive to something negatives. In other words, sports participation may actually discourage some children from being physically active.

Another current intervention is to reduce the amount of time that a child spends in front of a screen of some sort. Screens, whether computer screens, video game screens, or television screens all encourage children to be passive recipients of entertainment, rather than active players in a game of some sort. What is fascinating is that merely aiming to reduce screen time seems to be sufficient to help increase child health. The Stanford Student Media Awareness to Reduce Television (SMART) classroom program aimed at reducing children's screen time, but did not promote a substitute physical activity for that reduced screen time (Robinson, 1999). Simply reducing screen time was linked to reduced BMI, reduced body fat, and reduced waist circumference (Robinson, 1999). Presumably, this positive impact of reduced screen time comes as the result of two factors. First, screen time is often linked to mindless eating, which increases calorie consumption. Second, kids who are not in front of a screen are going to be more likely to engage in some physical activity, even if not specifically directed to substitute physical activity for the screen-watching activity.

Expected Outcomes

The problem with requiring active transport to and from school is that it is time consuming. Many people already feel very pressed for time and simply do not make time for exercise a priority in their personal lives. Even those who do regularly carve out time for exercise in their personal lives may not want to give time to active transport for the child to and from school because walking with a child to school rarely gives an adult the type of high intensity workout that one might seek to achieve. In other words, fit parents cannot substitute 20 minutes of walking to and from school for 20 minutes on the Stairmaster, and they have to find that 20 minutes somewhere. Likewise, particularly for working parents, the evening rush to get children home, fed, homework done, and bathed by bedtime will make it seem impossible for many of them to commit to actively transporting their children to and from school. Therefore, one expects a high drop-out rate among the program.

However, among the parents who continue participation in the program, the expected outcomes are very positive. One would expect that the children being actively transported to school would have positive health changes in BMI, body fat percentage, and waist circumference as compared with a control-group of students who are passively transported to school. Moreover, one would expect children who are actively transported to school to experience positives that, while not overtly related to childhood obesity, are likely to increase their overall mental and physical health. For example, one would anticipate that children who are actively transported to school with a parent's assistance would have a closer relationship and better communication with the parent as compared to children in the control group. Therefore, even if the activity does not have a positive impact on the child's weight, one would expect that child to suffer from fewer of the negative psychological health consequences that are attendant to childhood obesity. Finally, parents who walk their children to school have a greater opportunity to observe their child's interactions with peers, teachers, and other adults at school. Does the child appear to have friends, do other children pick on the child, and do teachers seem happy to see the child? A parent walking a kid to the schoolhouse door has many more opportunities to notice these interactions than a parent dropping off a child in a carpool lane.

Conclusion

Because childhood obesity is a multi-layered problem, no single intervention is going to be enough to fix the problem for all children or to fix the entire problem for a single child. A child who is already struggling with childhood obesity is not going to suddenly have an acceptable BMI simply because his parents have started walking him to and from school. However, the reality is that a single intervention, on its own, should not be expected to fix the problem. If the intervention helps alleviate the problem, then it should be considered successful. If a ten-minute walk to and from school increases a child's daily activity from 20 minutes per day to 40 minutes per day, even though the child is still 20 minutes short of the recommended activity guidelines, few people could suggest that the intervention was not successful. Moreover, by getting parents involved in the exercise program, one would hope to see some spillover effect into other parts of the child's life. Maybe the parent and child will come to value their walks together, and institute walks during the weekend or increase the frequency or duration of their walks to and from school. Perhaps the parent will see the positive impact of exercise and try to make small dietary changes. The important thing to keep in mind is that even small positive changes are still positive, and that it is easier to get people to commit to small changes and keep those commitments than it is to get people to make radical overnight changes.